Malaria Disease Burden Research Articles

Is World Malaria Day an effective awareness campaign? An evaluation of public interest in malaria during World Malaria Day.

We retrospectively analysed the relative search interest of malaria to (1) assess the relationship between Internet searches for malaria and rates of infection in 11 countries considered 'high burden' by WHO in 2019 and to (2) determine the ability of World Malaria Day on April 25 to generate interest in the disease. Using Google Trends, we sought to determine the relative popularity of the topic of Malaria over 4years (2015-2019). Worldwide and country-specific searches for 'malaria' were used to assess the influence the international awareness day has on global and local interest in malaria. In order to determine whether a relationship exists between Internet searches and the disease burden of malaria, the information gathered from Google Trends was then compared with reports of morbidity and mortality of malaria from the 2019 World Malaria Report. Globally, a negative mean difference in relative search volume was observed between World Malaria Day and the control periods of -2.46 (95% CI: -5.57 to 0.66). The relative search volume for malaria-related search terms increased by 2.91% (±4.60) from January 2015 to 1 July 2019 in the 5 countries with the highest malaria disease burden. A positive correlation (r=0.804) was found between per capita infections and malaria Internet search interest in addition to deaths per 1000 residents and malaria relative search interest (r=0.663) between 2015 and 2018. Initiatives such as World Malaria Day may help raise public awareness concerning a specific disease, prompting individuals to seek out additional information. This is especially important in high-burden countries where access to the Internet is steadily growing. In these circumstances, having quality and easily accessible information is vital in the continuing fight against malaria.

What does the COVID-19 pandemic mean for HIV, tuberculosis, and malaria control?

Despite its current relatively low global share of cases and deaths in Africa compared to other regions, coronavirus disease 2019 (COVID-19) has the potential to trigger other larger crises in the region. This is due to the vulnerability of health and economic systems, coupled with the high burden of human immunodeficiency virus (HIV), tuberculosis (TB), and malaria. Here we examine the potential implications of COVID-19 on the control of these major epidemic diseases in Africa. We use current evidence on disease burden of HIV, TB, and malaria, and epidemic dynamics of COVID-19 in Africa, retrieved from the literature. Our analysis shows that the current measures to control COVID-19 neglect important and complex context-specific epidemiological, social, and economic realities in Africa. There is a similarity of clinical features of TB and malaria, with those used to track COVID-19 cases. This coupled with institutional mistrust and misinformation might result in many patients with clinical features similar to those of COVID-19 being hesitant to voluntarily seek care in a formal health facility. Furthermore, most people in productive age in Africa work in the informal sector, and most of those in the formal sector are underemployed. With the current measures to control COVID-19, these populations might face unprecedented difficulties to access essential services, mainly due to reduced ability of patients to support direct and indirect medical costs, and unavailability of transportation means to reach health facilities. Therefore, if not accompanied with appropriate economic and epidemiological considerations, we anticipate that these measures might result in unprecedented difficulties among vulnerable segments of society to access essential services, including antiretroviral and prophylactic drugs among people living with HIV and Acquired Immune Deficiency Syndrome, anti-tuberculosis drugs, and curative and preventive treatments for malaria among pregnant women and children. This might increase the propensity of patients taking substandard doses and/or medicines, which has the potential to compromise drug efficacy, and worsen health inequalities in the region. COVID-19 responses at country level should include measures to protect vulnerable and under-served segments of society.

Has India met this enemy before? From an eternal optimist’s perspective: SARS-CoV-2

Objective:We are presently going through a historic and unprecedented crisis for humanity with SARS-CoV-2 causing immense damage to life and world economics. It has been 3 months, since we had the first cluster in China and we felt the need to look into certain regional patterns of transmission of the virus with respect to some distinctive living conditions, incidence of malaria, the genomics of different strains, and its impact on severity.Material and Methods:Data for 107 countries was compiled and correlation analysis was done between incidence of malaria and number of SARS-CoV-2 cases. Possibility of genetic similarity between SARS-CoV-2 and reported zoonotic RNA viruses found associated previously with some Plasmodium species was explored by utilizing NCBI database.Results:We found a significant inverse correlation between SARS-CoV-2 disease burden and incidence of Malaria. Our analysis also showed that a 12 base pair region encoding a part of surface glycoprotein of SARS- CoV-2 aligned with the Plasmodium associated zoonotic viral genome.Conclusion:Our analysis suggests a significantly lower SARS-CoV-2 disease burden in Malaria endemic regions and an inverse correlation with incidence of Malaria. The possibility of a pre-existing immunological memory for SARS-CoV-2 in Indians is possible and needs to be explored further

A systematic review of changing malaria disease burden in sub-Saharan Africa since 2000: comparing model predictions and empirical observations

BackgroundThe most widely used measures of declining burden of malaria across sub-Saharan Africa are predictions from geospatial models. These models apply spatiotemporal autocorrelations and covariates to parasite prevalence data and then use a function of parasite prevalence to predict clinical malaria incidence. We attempted to assess whether trends in malaria cases, based on local surveillance, were similar to those captured by Malaria Atlas Project (MAP) incidence surfaces.MethodsWe undertook a systematic review (PROSPERO International Prospective Register of Systematic Reviews; ID = CRD42019116834) to identify empirical data on clinical malaria in Africa since 2000, where reports covered at least 5 continuous years. The trends in empirical data were then compared with the trends of time-space matched clinical malaria incidence from MAP using the Spearman rank correlation. The correlations (rho) between changes in empirically observed and modelled estimates of clinical malaria were displayed by forest plots and examined by meta-regression.ResultsSixty-seven articles met our inclusion criteria representing 124 sites from 24 African countries. The single most important factor explaining the correlation between empirical observations and modelled predictions was the slope of empirically observed data over time (rho = − 0.989; 95% CI − 0.998, − 0.939; p < 0.001), i.e. steeper declines were associated with a stronger correlation between empirical observations and modelled predictions. Factors such as quality of study, reported measure of malaria and endemicity were only slightly predictive of such correlations.ConclusionsIn many locations, both local surveillance data and modelled estimates showed declines in malaria burden and hence similar trends. However, there was a weak association between individual surveillance datasets and the modelled predictions where stalling in progress or resurgence of malaria burden was empirically observed. Surveillance data were patchy, indicating a need for improved surveillance to strengthen both empiric reporting and modelled predictions.

Mosquitoes are not the major culprits for the high burden of malaria in Nigeria: a commentary.

Globally, Nigeria contributes the greatest proportion of the malaria disease burden. She currently bears the heaviest malaria burden (25% cases) and (19% deaths). Malaria is caused by Plasmodium parasites transmitted by female Anopheles mosquitoes however, a higher parasite biomass (99%) is found in man while only one (1%) is found in mosquitoes. Lending credence to this is the outcome of investigations carried out in Gboko and Otukpo Local Government Areas (LGAs); in which more humans (36.8%) had the malaria parasites than the anthropophagic female Anopheles (0.5%). Control efforts focused on mosquitoes are undermined by the actions or inactions of humans. Nigeria needs to self-audit her role in sustaining the heaviest burden of a preventable, curable disease that can also be eliminated. She can only ignore this imperative at her own peril.

Malaria in China: a longitudinal population-based surveillance study.

This study aims to ascertain the long-term epidemic trends of malaria and evaluates the probability of achieving the eradication goal by 2020 in China. Data on malaria incidence and deaths were extracted from the China Information System for Disease Control and Prevention. The epidemic trends by sex, age and spatial distribution and predictions of malaria were estimated by using Joinpoint and Poisson regressions. From 1950 to 2016, 227 668 374 malaria cases were reported in China, with an annualised average incidence of 337.02 (336.98-337.07, 95% confidence interval (CI)) per 100 000 population. The incidence decreased with an average annual per cent change (AAPC) of -11.4% (-16.6 to -6.0). There were 36 085 malaria deaths, with an annualised average mortality of 0.534 (0.529-0.540) per 1 000 000 population. The mortality decreased with an AAPC of -8.7% (-13.7 to -3.4). The predicted number of malaria cases and deaths for 2020 is 2 562 and 10, respectively, and zero for indigenous cases. The disease burden of malaria dramatically decreased in China. Though, the goal of malaria elimination is realistic by 2020 in China, routine clinical and entomological surveillance should be continually conducted, especially for the cross-border areas and imported malaria cases.

Assessing the role of human mobility on malaria transmission

South Sudan accounts for a large proportion of all annual malaria cases in Africa. In recent years, the country has witnessed an unprecedented number of people on the move, refugees, internally displaced people, people who have returned to their counties or areas of origin, stateless people and other populations of concern, posing challenges to malaria control. Thus, one can claim that human mobility is one of the contributing factors to the resurgence of malaria. The aim of this paper is to assess the impact of human mobility on the burden of malaria disease in South Sudan. For this, we formulate an SIR-type model that describes the transmission dynamics of malaria disease between multiple patches. The proposed model is a system of stochastic differential equations consisting of ordinary differential equations perturbed by a stochastic Wiener process. For the deterministic part of the model, we calculate the basic reproduction number. Concerning the whole stochastic model, we use the maximum likelihood approach to fit the model to weekly malaria data of 2011 from Central Equatoria State, Western Bahr El Ghazal State and Warrap State. Using the parameters estimated on the fitted model, we simulate the future observation of the disease pattern. The disease was found to persist in the low transmission patches when there is human inflow in these patches and although the intervention coverage reaches 75%.

Humoral immunity prevents clinical malaria during Plasmodium relapses without eliminating gametocytes.

Plasmodium relapses are attributed to the activation of dormant liver-stage parasites and are responsible for a significant number of recurring malaria blood-stage infections. While characteristic of human infections caused by P. vivax and P. ovale, their relative contribution to malaria disease burden and transmission remains poorly understood. This is largely because it is difficult to identify ‘bona fide’ relapse infections due to ongoing transmission in most endemic areas. Here, we use the P. cynomolgi–rhesus macaque model of relapsing malaria to demonstrate that clinical immunity can form after a single sporozoite-initiated blood-stage infection and prevent illness during relapses and homologous reinfections. By integrating data from whole blood RNA-sequencing, flow cytometry, P. cynomolgi-specific ELISAs, and opsonic phagocytosis assays, we demonstrate that this immunity is associated with a rapid recall response by memory B cells that expand and produce anti-parasite IgG1 that can mediate parasite clearance of relapsing parasites. The reduction in parasitemia during relapses was mirrored by a reduction in the total number of circulating gametocytes, but importantly, the cumulative proportion of gametocytes increased during relapses. Overall, this study reveals that P. cynomolgi relapse infections can be clinically silent in macaques due to rapid memory B cell responses that help to clear asexual-stage parasites but still carry gametocytes.

Application of community-based and integrated strategy to reduce malaria disease burden in southern Tanzania: the study protocol of China-UK-Tanzania pilot project on malaria control

BackgroundDuring the past six decades, remarkable success on malaria control has been made in China. The major experience could be shared with other malaria endemic countries including Tanzania with high malaria burden. Especially, China’s 1–3-7 model for malaria elimination is one of the most important refined experiences from many years’ efforts and key innovation measures for malaria elimination in China.MethodsThe China-UK-Tanzania pilot project on malaria control was implemented from April, 2015 to June, 2018, which was an operational research with two communities receiving the proposed interventions and two comparable communities serving as control sites. The World Health Organization “Test, Treat, Track” (WHO-T3) Initiative, which calls for every suspected case to receive a diagnostic test, every confirmed case to be treated, and for the disease to be tracked, was integrated with Chinese experiences on malaria control and elimination for exploration of a proper model tailored to the local settings. Application of China’s 1–3-7 model integrating with WHO-T3 initiative and local resources aiming at reducing the burden of malaria in terms of morbidity and mortality by 30% in the intervention communities in comparison with that at the baseline survey.DiscussionThe China-UK-Tanzania pilot project on malaria control was that at China's first pilot project on malaria control in Africa, exploring the feasibility of Chinese experiences by China-Africa collaboration, which is expected that the strategies and approaches used in this project could be potential for scaling up in Tanzania and African countries, and contribute to the acceleration of malaria control and elimination in Africa.

Neglected Tropical Diseases in the Central African Region: A Review of their Mass Treatment Coverage

Background: The neglected tropical diseases (NTDs) are the most common conditions affecting the poorest 600 million people living in sub-Saharan Africa (SSA) of which the Central African region is part and parcel, and together produce a burden of disease that may be equivalent to one-half of SSA’s malaria disease burden and more than double that caused by tuberculosis. Establishing specific information on the mass treatment coverage would provide a basis for prioritizing control strategies as a means to address the Sustainable Development Goals (SDGs). The objective of this review was to determine the mass treatment coverage trend resulting from 5 NTDs amenable to mass treatment in the Central African region. Methods: A search on PubMed, ScienceDirect, Uniting to Combat NTDs, Cochrane Library, African Journals Online, MEDLINE, Scopus and Google Scholar with the following Keywords: “Neglected Tropical Diseases”, “Mass Treatment Coverage”, “Control”, “Elimination”, “Lymphatic filariasis”, “Onchocerciasis”, “Schistosomiasis”, “Soil-transmitted helminthiases”, “Trachoma was conducted, with the Medical Subject Headings (MeSH), with specific diseases listed as 5 NTDs amenable to mass treatment per Central Africa region country. Studies to assess the mass treatment coverage resulting from 5 NTDs amenable to treatment in Central Africa as the primary outcome variable, were included. Our search was limited to, articles published from the year 2013 to 2018 (A 5 years review) in English and French. The search identified a total of 140 articles amongst which 10 data-based reports and 5 original articles met the inclusion criteria to give a total of 15 papers that were considered. Results: Our review shows that, in the Central African region, Cameroon has the highest mass treatment coverage index (58/100) for 5 NTDs while Rwanda, Gabon, Equatorial Guinea, Sao Tome and Principe had mass treatment coverage indexes of 3/100, 1/100, 0/100, 0/100 respectively indicating the need for coordinated action in filling the missing gaps. Also, in the Central African region; over 66 million people received NTD treatment and those who didn’t receive NTD treatment were over 27 million. Conclusion: There is a need for more data on progress made in reaching people in need of NTD Mass treatment. The way forward paradigm in achieving the control and elimination of NTDs amenable to mass treatment in Central African countries will be to establish, and sustain a task force on NTDs at the African Union, set up a sustainable fund for neglected tropical diseases at the Africa Union, Regularly monitor and report on progress on neglected tropical diseases while recognizing and celebrating countries as they achieve elimination goals. Equally, operational studies on assessing the rate and impact of NTDs mass treatment coverage in the Central African region should be carried out.

The Burden of Adverse Drug Reactions Due to Artemisinin-Based Antimalarial Treatment in Selected Ugandan Health Facilities: An Active Follow-Up Study.

IntroductionUganda has rapidly increased access to antimalarial medicines in an effort to address the huge malaria disease burden. Pharmacovigilance information is important to guide policy decisions.ObjectivesThe purpose of this study was to establish the burden of adverse drug reactions (ADRs) and associated risk factors for developing ADRs to artemisinin-based antimalarial treatment in Uganda.MethodsAn active follow-up study was conducted between April and July 2017 in a cohort of patients receiving treatment for uncomplicated malaria in the Iganga, Mayuge, and Kampala districts.ResultsA total of 782 patients with a median age of 22 years (58.6% females) were recruited into this study, with the majority recruited from public health facilities (97%). Diagnostic tests before treatment were performed for 76% of patients, and 97% of patients received artemether/lumefantrine. The prevalence of ADRs was 22.5% (176/782); however, the total number of ADRs was 245 since some patients reported more than one ADR. The most commonly reported reactions were general body weakness (24%), headache (13%), and dizziness (11%). Women were more likely to develop an ADR (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.1–2.9), urban dwellers were more likely to develop an ADR than rural residents (aOR 9.9, 95% CI 5.4–17.9), and patients with comorbidities were more likely to develop an ADR than those without (aOR 7.4, 95% CI 4.4–12.3).ConclusionThe burden of ADRs is high among women and in patients from urban settings and those with comorbidities. Such risk factors need to be considered in order to optimise therapy. Close monitoring of ADRs is key in implementation of the malaria treatment policy.Electronic supplementary materialThe online version of this article (10.1007/s40264-018-0659-x) contains supplementary material, which is available to authorized users.

Malaria training for community health workers in the setting of elimination: a qualitative study from China

BackgroundContinuous training of health workers is a key intervention to maintain their good performance and keep their vigilance during malaria elimination programmes. However, countries progressing toward malaria elimination have a largely decreased malaria disease burden, less frequent exposure of health workers to malaria patients, and new challenges in the epidemiology of the remaining malaria cases. Moreover, competing health priorities and usually a decline in resources and in political commitment also pose challenges to the elimination programme. As a consequence, the acceptability, sustainability, and impact of malaria training and education programmes face challenges. However, little is known of the perceptions and expectations of malaria training and education programmes of health workers being engaged in countries with malaria elimination programmes.MethodsThis qualitative study provides information on perceptions and expectations of health workers of malaria training programmes from China, which aims to malaria elimination by the year 2020. This study was embedded into a larger study on the challenges and lessons learned during the malaria surveillance strategy in China, involving 42 interviews with malaria experts, health staff, laboratory practitioners, and village doctors at the provincial, city, county, township, and village levels from Gansu province (northwestern China) and Jiangsu province (southeastern China).ResultsIn the context of an increasing number of imported malaria cases in China, the majority of respondents emphasized the necessity and importance of such programmes and complained about a decreasing frequency of training courses. Moreover, they called for innovative strategies to improve the implementation and sustainability of the malaria training programmes until the elimination goal has been achieved. Perceptions and expectations of health workers from different health centres were quite different. Health workers from higher-level facilities were more concerned about technical training aspects, while health workers from periphery of the health system expected to receive more training on field work coordination and on specific public health actions with regard to case detection and focus investigation.ConclusionsThere is need to guarantee an ongoing good training of health workers in China on malaria aspects until the year 2020 and probably beyond.

Impact of insecticide resistance in Anopheles arabiensis on malaria incidence and prevalence in Sudan and the costs of mitigation

Insecticide-based interventions have contributed to ∼78% of the reduction in the malaria burden in sub-Saharan Africa since 2000. Insecticide resistance in malaria vectors could presage a catastrophic rebound in disease incidence and mortality. A major impediment to the implementation of insecticide resistance management strategies is that evidence of the impact of resistance on malaria disease burden is limited. A cluster randomized trial was conducted in Sudan with pyrethroid-resistant and carbamate-susceptible malaria vectors. Clusters were randomly allocated to receive either long-lasting insecticidal nets (LLINs) alone or LLINs in combination with indoor residual spraying (IRS) with a pyrethroid (deltamethrin) insecticide in the first year and a carbamate (bendiocarb) insecticide in the two subsequent years. Malaria incidence was monitored for 3 y through active case detection in cohorts of children aged 1 to <10 y. When deltamethrin was used for IRS, incidence rates in the LLIN + IRS arm and the LLIN-only arm were similar, with the IRS providing no additional protection [incidence rate ratio (IRR) = 1.0 (95% confidence interval [CI]: 0.36-3.0; P = 0.96)]. When bendiocarb was used for IRS, there was some evidence of additional protection [interaction IRR = 0.55 (95% CI: 0.40-0.76; P < 0.001)]. In conclusion, pyrethroid resistance may have had an impact on pyrethroid-based IRS. The study was not designed to assess whether resistance had an impact on LLINs. These data alone should not be used as the basis for any policy change in vector control interventions.

Why Is Inequality High in Africa?†

This paper computed asset-based inequality for 38 African countries in multiple waves, using over a million household histories, to study why inequality tends to be persistently high in Africa. The results show that within-country asset inequality is positively correlated with the returns to higher education, a finding that is corroborated by results showing a negative correlation between consumption-based inequality and the proportion of households that completed tertiary education. Countries with higher remittance flows also experienced lower inequality, whereas assets and goods market distortions tended to increase inequality in Africa. The paper also decomposed within-country inequality into components deemed to represent opportunities beyond the control of individuals and those attributed to individual efforts, such as education. At least 30% of asset inequality within countries was, on average, due to inequality of opportunity, though there were considerable differences across countries. In addition, the incidence of child mortality and disease burden of malaria and tuberculosis tended to increase with asset-based inequality of opportunity, which increased with ethnic fractionalisation but decreased with improved governance.

State of inequality in malaria intervention coverage in sub-Saharan African countries

BackgroundScale-up of malaria interventions over the last decade have yielded a significant reduction in malaria transmission and disease burden in sub-Saharan Africa. We estimated economic gradients in the distribution of these efforts and of their impacts within and across endemic countries.MethodsUsing Demographic and Health Surveys we computed equity metrics to characterize the distribution of malaria interventions in 30 endemic countries proxying economic position with an asset-wealth index. Gradients were summarized in a concentration index, tabulated against level of coverage, and compared among interventions, across countries, and against respective trends over the period 2005–2015.ResultsThere remain broad differences in coverage of malaria interventions and their distribution by wealth within and across countries. In most, economic gradients are lacking or favor the poorest for vector control; malaria services delivered through the formal healthcare sector are much less equitable. Scale-up of interventions in many countries improved access across the wealth continuum; in some, these efforts consistently prioritized the poorest. Expansions in control programs generally narrowed coverage gaps between economic strata; gradients persist in countries where growth was slower in the poorest quintile or where baseline inequality was large. Despite progress, malaria is consistently concentrated in the poorest, with the degree of inequality in burden far surpassing that expected given gradients in the distribution of interventions.ConclusionsEconomic gradients in the distribution of interventions persist over time, limiting progress toward equity in malaria control. We found that, in countries with large baseline inequality in the distribution of interventions, even a small bias in expansion favoring the least poor yielded large gradients in intervention coverage while pro-poor growth failed to close the gap between the poorest and least poor. We demonstrated that dimensions of disadvantage compound for the poor; a lack of economic gradients in the distribution of malaria services does not translate to equity in coverage nor can it be interpreted to imply equity in distribution of risk or disease burden. Our analysis testifies to the progress made by countries in narrowing economic gradients in malaria interventions and highlights the scope for continued monitoring of programs with respect to equity.

Spatiotemporal Modeling for Fine-Scale Maps of Regional Malaria Endemicity and Its Implications for Transitional Complexities in a Routine Surveillance Network in Western Cambodia.

Due to the associated and substantial efforts of many stakeholders involved in malaria containment, the disease burden of malaria has dramatically decreased in many malaria-endemic countries in recent years. Some decades after the past efforts of the global malaria eradication program, malaria elimination has again featured on the global health agenda. While risk distribution modeling and a mapping approach are effective tools to assist with the efficient allocation of limited health-care resources, these methods need some adjustment and reexamination in accordance with changes occurring in relation to malaria elimination. Limited available data, fine-scale data inaccessibility (for example, household or individual case data), and the lack of reliable data due to inefficiencies within the routine surveillance system, make it difficult to create reliable risk maps for decision-makers or health-care practitioners in the field. Furthermore, the risk of malaria may dynamically change due to various factors such as the progress of containment interventions and environmental changes. To address the complex and dynamic nature of situations in low-to-moderate malaria transmission settings, we built a spatiotemporal model of a standardized morbidity ratio (SMR) of malaria incidence, calculated through annual parasite incidence, using routinely reported surveillance data in combination with environmental indices such as remote sensing data, and the non-environmental regional containment status, to create fine-scale risk maps. A hierarchical Bayesian frame was employed to fit the transitioning malaria risk data onto the map. The model was set to estimate the SMRs of every study location at specific time intervals within its uncertainty range. Using the spatial interpolation of estimated SMRs at village level, we created fine-scale maps of two provinces in western Cambodia at specific time intervals. The maps presented different patterns of malaria risk distribution at specific time intervals. Moreover, the visualized weights estimated using the risk model, and the structure of the routine surveillance network, represent the transitional complexities emerging from ever-changing regional endemic situations.

Optimization of 2-Anilino 4-Amino Substituted Quinazolines into Potent Antimalarial Agents with Oral in Vivo Activity.

Novel antimalarial therapeutics that target multiple stages of the parasite lifecycle are urgently required to tackle the emerging problem of resistance with current drugs. Here, we describe the optimization of the 2-anilino quinazoline class as antimalarial agents. The class, identified from publicly available antimalarial screening data, was optimized to generate lead compounds that possess potent antimalarial activity against P. falciparum parasites comparable to the known antimalarials, chloroquine and mefloquine. During the optimization process, we defined the functionality necessary for activity and improved in vitro metabolism and solubility. The resultant lead compounds possess potent activity against a multidrug resistant strain of P. falciparum and arrest parasites at the ring phase of the asexual stage and also gametocytogensis. Finally, we show that the lead compounds are orally efficacious in a 4 day murine model of malaria disease burden.

A Malaria Ecology Index Predicted Spatial and Temporal Variation of Malaria Burden and Efficacy of Antimalarial Interventions Based on African Serological Data

Reducing the global health burden of malaria is complicated by weak reporting systems for infectious diseases and a paucity of vital statistics registration. This limits our ability to predict changes in malaria health burden intensity, target antimalarial resources where needed, and identify malaria impacts in retrospective data. We refined and deployed a temporally and spatially varying Malaria Ecology Index (MEI) incorporating climatological and ecological data to estimate malaria transmission strength and validate it against cross-sectional serology data from 39,875 children from seven sub-Saharan African countries. The MEI is strongly associated with malaria burden; a 1 standard deviation higher MEI is associated with a 50-117% increase in malaria risk and a 3-5 g/dL lower level of Hg. Results show that the relationship between malaria ecology and disease burden is attenuated with sufficient coverage of insecticide treated nets (ITNs) or indoor residual spraying (IRS). Having both ITNs and IRS reduce the added risk from adverse malaria ecology conditions by half. Readily available climate and ecology data can be used to estimate the spatial and temporal variation in malaria disease burden, providing a feasible alternative to direct surveillance. This will help target resources for malaria programs in the absence of national coverage of active case detection systems, and facilitate malaria research using retrospective health data.

Post Marketing Surveillance of Anti-malarial Medicines in Tanzania

Background: Presence of substandard and falsified anti-malarial medicines is a major concern in countries with high prevalence of malaria. Systematic assessment and monitoring of anti-malarial medicines circulating on the market is critical to National Medicines Regulatory Authorities (NMRAs) in ensuring quality of these products in the fight against the burden of malaria disease. Objectives: This survey was conducted by Tanzania Food and Drugs Authority (TFDA) with the aim of monitoring the quality of registered anti-malarial medicines circulating on the market in Tanzania Mainland. Methodology: Purposive sampling method was used in obtaining the samples of anti-malarial medicines from 21 out of 26 regions of Tanzania Mainland between 2012 and 2015. These medicines were collected from ports of entry, domestic manufacturers, Medical Stores Department (MSD), wholesalers, hospitals, health centres, dispensaries and retail pharmacy outlets. Samples were subjected to product information review and quality screening using Global Pharma Health Fund® (GPHF) Mini-Lab kits. Samples failing or yielding doubtful results and ten percent (10%) of passed samples were subjected to tier two confirmatory testing using full pharmacopeial monographs at TFDA-WHO prequalified quality control laboratory. Results: A total of 1,444 samples of oral solid formulations from different types of anti-malarials were sampled. Out of these, 132 (9.1%) failed labelling product information requirements. A high percentage of samples passed identification test by TLC (97.9%) and disintegration test (99.8%). A 4.8% (7/145) failure rate was observed in confirmatory testing of which one of the failed samples namely quinine sulphate 300 mg tablets was confirmed to be falsified. Conclusion: These results indicate the importance of post marketing surveillance as an additional measure of assuring the quality of medicines by Regulators following marketing authorization and as a way of detecting falsified medicines circulating on the market.

The effect of mass mosquito trapping on malaria transmission and disease burden (SolarMal): a stepped-wedge cluster-randomised trial

Odour baits can attract host-seeking Anopheles mosquitoes indoors and outdoors. We assessed the effects of mass deployment of odour-baited traps on malaria transmission and disease burden. We installed solar-powered odour-baited mosquito trapping systems (SMoTS) to households on Rusinga Island, Lake Victoria, western Kenya (mean population 24 879), in a stepped-wedge cluster-randomised trial. All residents in the completed health and demographic surveillance system were eligible to participate. We used the travelling salesman algorithm to assign all households to a cluster (50 or 51 geographically contiguous households); nine contiguous clusters formed a metacluster. Initially, no cluster had SMoTS (non-intervened). During the course of the intervention roll-out SMoTS were gradually installed cluster by cluster until all clusters had SMoTS installed (intervened). We generated 27 cluster randomisations, with the cluster as unit of randomisation, to establish the order to install the traps in the clusters until all had a SMoTS installed. Field workers and participants were not masked to group allocation. The primary outcome of clinical malaria was monitored through repeated household visits covering the entire population, once before roll-out (baseline) and five times throughout the 2-year roll-out. We measured clinical malaria as fever plus a positive result with a rapid diagnostic test. The SolarMal project was registered on the Dutch Trial Register (NTR 3496). We enrolled 34 041 participants between April 25, 2012, and March 23, 2015, to 81 clusters and nine metaclusters. 4358 households were provided with SMoTS during roll-out between June 3, 2013, and May 16, 2015. 23 clinical malaria episodes were recorded in intervened clusters and 33 episodes in non-intervened clusters (adjusted effectiveness 40·8% [95% CI -172·8 to 87·1], p=0·5) during the roll-out. Malaria prevalence measured by rapid diagnostic test was 29·8% (95% CI 20·9-38·0) lower in SMoTS clusters (prevalence 23·7%; 1552 of 6550 people) than in non-intervened clusters (prevalence 34·5%; 2002 of 5795 people). The unexpectedly low clinical incidence of malaria during roll-out led to an imprecise estimate of effectiveness from the clinical incidence data. The substantial effect on malaria prevalence is explained by reduction in densities of Anopheles funestus. Odour-baited traps might be an effective malaria intervention. COmON Foundation.